Olivier Camuzard

Severe granulomatous reaction associated with hypercalcemia occurring after silicone soft tissue augmentation of the buttocks: a case report.

Liquid silicone is a permanent filler. Its use to augment soft tissues for aesthetic purposes was widespread worldwide in the 1960s. Although initially considered to be biologically inert, this substance may cause, after its injection, an inflammatory granulomatous effect of variable severity and, in very rare cases, a severe hypercalcemia, which can be life threatening. The reported case highlights the well-known physiopathology of hypercalcemia, and the various therapeutic options are discussed.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Inferior Cubital Artery Perforator Flap for Soft-tissue Coverage of the Elbow: Anatomical Study and Clinical Application

BACKGROUND Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow. METHODS Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators. RESULTS A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months. CONCLUSIONS The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction. CLINICAL RELEVANCE The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.

Is it possible to give a single definition of the rectosigmoid junction

AimThe rectosigmoid junction is the limit separating the sigmoid colon and rectum. This transition zone has different definitions. We want to highlight different landmarks of the rectosigmoid junction (RSJ), to help the clinicians to adopt a consensual definition.MethodWe reviewed anatomical, endoscopic, physiological and surgical points of view concerning the rectosigmoid junction (RSJ).ResultsThe rectosigmoid junction has a different definition depending on who is studying it. Nevertheless, it is a high pressure location, a place connecting different muscles organizations, neurological systems or vascular anastomosis. The clear pathophysiology of the RSJ is not yet determined with certainty, but its resection is essential for the therapeutic care of patients and also for the improvement of surgical skills. From a surgical point of view, anatomical landmarks has to be chosen: easily reproducible and identifiable. The disappearance of taenia coli (belonging to the colon) and the peritoneal reflection (recto-genital pouch), located below the upper rectum, seem the most reliable. The level of rectal section must, in any case, be below the promontory.ConclusionThere is not a single definition, but rather several definitions of the RSJ. Each one of them reflects one appearance of this region: embryological and anatomical evolution or clinical entity. From a surgical point of view, the criterion which seems to be the most reliable is the disappearance of taenia coli and the peritoneal reflection (recto-genital pouch).

Coverage of Tendon Exposure after Radial Forearm Free Flap by the Dorsoulnar Artery Perforator Flap

Objective This study was designed to assess the effectiveness of an alternative technique using a perforator flap to manage secondary tendon exposure after a radial forearm free flap in head and neck oncologic surgery. Study Design Prospective cohort study. Setting Plastic Reconstructive Surgery Unit, Nice University Hospital, Pasteur 2 Hospital, France. Subjects and Methods Despite its numerous advantages, the radial forearm free flap is associated with significant donor site morbidity and the risk of secondary tendon exposure. Conventional skin grafts for secondary tendon exposure can lead to diminished wrist range of motion and grip strength, with residual pain and cold intolerance. Between 2012 and 2015, we prospectively studied 20 patients with secondary tendon exposure after a forearm radial free flap for head and neck reconstruction. Two techniques of secondary coverage were compared: a reference technique with a secondary full skin graft (10 patients) and a dorsoulnar artery perforator (DUAP) flap (10 patients). Results Maximum wrist extension (100%) was observed for the DUAP group compared with only 87% for the skin graft (SG) group (P = .001). An improvement in grip strength (+14 kg) (P = .028) and a decrease in pain or cold intolerance (P = .002) were also observed in the DUAP group, in addition to a better aesthetic appearance. Conclusion The perforator flap procedure is an interesting tool in reconstructive surgery. The DUAP flap is a reliable, useful flap for secondary tendon exposure coverage after a radial forearm free flap. Level of Evidence III (case-control analytic studies of 1 center).

Tumeurs glomiques des membres supérieurs – évaluation des résultats cliniques et fonctionnels par une étude rétrospective monocentrique

Glomus tumors are rare and benign hamartomas, arising from neuro-myoarterial proliferation and deriving from mesenchymal origin. As they have a long-term impact on the individuals quality of life, the primary complaint is unbearable pain. The aim of this study was to assess the clinical and functional outcomes of their surgical treatment, and to review their clinical, radiological and therapeutic features. We performed a retrospective study over a 16-year period including 31 patients with an upper limb glomus tumor. Epidemiologic, diagnostic, therapeutic and follow-up data were collected and a functional outcome questionnaire was filled out postoperatively. Thirty-one patients underwent surgery with safe macroscopic resection margins. The glomus tumor was located on the fingers in 77.4% of cases, with predominance in the ring finger (41.9% of the cases). Patient age at surgery ranged from 22 to 80 years old (mean: 54.6) with a sex ratio of 0.48. Upon clinical suspicion, magnetic resonance imaging and ultrasound were done in most cases. Immediate pain relief was obtained in 18 cases. Only one patient underwent a second surgery for incomplete removal and persistent pain. The QuickDASH questionnaire was completed by 24 patients, resulting in a mean score of 1.61, with a mean follow-up time of 88.8 months (range: 3–171 months). Seven patients were lost to follow-up. These subcutaneous, mostly subungual, nodules, with predominance on the ring finger, have a disproportionate negative impact despite their small size. The long-term outcomes after microscope-assisted surgery indicate obvious improvement in the quality of life and the patients satisfaction, with a very low rate of recurrence.

Glomus tumors of the upper limb: Single-center retrospective study of clinical and functional outcomes

Glomus tumors are rare and benign hamartomas, arising from neuro-myo-arterial proliferation and deriving from mesenchymal origin. As they have a long-term impact on the individuals quality of life, the primary complaint is unbearable pain. The aim of this study was to assess the clinical and functional outcomes of their surgical treatment, and to review their clinical, radiological and therapeutic features. We performed a retrospective study over a 16-year period including 31 patients with an upper limb glomus tumor. Epidemiologic, diagnostic, therapeutic and follow-up data were collected and a functional outcome questionnaire was filled out postoperatively. Thirty-one patients underwent surgery with safe macroscopic resection margins. The glomus tumor was located on the fingers in 77.4% of cases, with predominance in the ring finger (41.9% of the cases). Patient age at surgery ranged from 22 to 80 years old (mean: 54.6) with a sex ratio of 0.48. Upon clinical suspicion, magnetic resonance imaging and ultrasound were done in most cases. Immediate pain relief was obtained in 18 cases. Only one patient underwent a second surgery for incomplete removal and persistent pain. The QuickDASH questionnaire was completed by 24 patients, resulting in a mean score of 1.61, with a mean follow-up time of 88.8 months (range: 3-171 months). Seven patients were lost to follow-up. These subcutaneous, mostly subungual, nodules, with predominance on the ring finger, have a disproportionate negative impact despite their small size. The long-term outcomes after microscope-assisted surgery indicate obvious improvement in the quality of life and the patients satisfaction, with a very low rate of recurrence.

A Modified Patient Positioning for Transaxillary Breast Augmentation

No Level Assigned This journal requires that authors assign a level of evidence to each submission to which EvidenceBased Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of

Intravenous Hyaluronidase with Urokinase as Treatment for Arterial Hyaluronic Acid Embolism.

1. Chiang C, Zhou S, Liu K. Intravenous hyaluronidase with urokinase as treatment for arterial hyaluronic acid embolism. Plast Reconstr Surg. 2016;137:114–121. 2. Ozturk CN, Li Y, Tung R, Parker L, Piliang MP, Zins JE. Complications following injection of soft-tissue fillers. Aesthet Surg J. 2013;33:862–877. 3. Cohen JL, Biesman BS, Dayan SH, et al. Treatment of hyaluronic acid filler-induced impending necrosis with hyaluronidase: Consensus recommendations. Aesthet Surg J. 2015;35:844–849. 4. DeLorenzi C. Transarterial degradation of hyaluronic acid filler by hyaluronidase. Dermatol Surg. 2014;40:832–841. 5. Sun ZS, Zhu GZ, Wang HB, et al. Clinical outcomes of impending nasal skin necrosis related to nose and nasolabial fold augmentation with hyaluronic acid fillers. Plast Reconstr Surg. 2015;136:434e–441e.